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Lee HY, Lin CH, Wang XA, Tsai JD. Neuropsychiatric comorbidities in tuberous sclerosis complex patients with epilepsy: results of the TAND checklist survey. Acta Neurol Belg 2024; 124:973-979. [PMID: 38523222 DOI: 10.1007/s13760-024-02510-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE In addition to epilepsy, individuals with tuberous sclerosis complex (TSC) experience a wide range of behavioral, psychiatric, intellectual, academic, and psychosocial problems. They usually exert a large psychological burden on individuals with these illnesses. METHODS This cross-sectional study used TSC-associated neuropsychiatric disorders (TAND) checklist interviews conducted at a single medical center. The enrollment of all subjects was > 6 years, and the comorbidities of neurodevelopmental disorders were assessed by clinical psychologists before enrollment. To assess the spectrum of TAND, the TAND checklist was applied as stated in the protocol, and the responses to the TAND checklist were evaluated by clinical psychologists. RESULTS In the behavioral concerns of patients with TSC without epilepsy, those with epilepsy had excessive shyness, language delay, lack of eye contact, rigid behavior, inattentiveness, and restlessness. In psychiatric disorders, autism spectrum disorder and attention-deficit/hyperactivity disorder are significantly correlated with epilepsy history. Diminished academic skills, including reading, writing, and mathematics skills, are significantly associated with epilepsy history. For intellectual ability, TSC patients without epilepsy is associated normal intelligence level. Among neuropsychological skills, deficits in attention, dual tasking/multi-tasking, visuospatial tasking, and executive skills are significantly associated with epilepsy history. CONCLUSIONS Epilepsy in patients with TSC contributes to comorbid neuropsychiatric disorders. In addition to epilepsy evaluation, it is crucial to evaluate the heterogeneous spectrum of neuropsychiatric disorders using a standard checklist during the annual clinical follow-up of patients with TSC.
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Affiliation(s)
- Hom-Yi Lee
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Room of Psychology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Heng Lin
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Paediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Xing-An Wang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Paediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Paediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Almuqbil M, Aldoohan W, Alhinti S, Almahmoud N, Abdulmajeed I, Alkhodair R, Kashgari A, Baarmah D, Altwaijri W, Alrumayyan A. Review of the spectrum of tuberous sclerosis complex: The Saudi Arabian Experience. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2024; 29:113-121. [PMID: 38740395 PMCID: PMC11305360 DOI: 10.17712/nsj.2024.2.20230061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To determine the prevalence of tuberous sclerosis complex (TSC) in the paediatric Saudi population and to characterise the range of clinical symptoms, neurocutaneous findings, neuroimaging results, and complications of the disease. METHODS A total of 61 genetically confirmed TSC patients from the National Guard Health Affairs (NGHA) in Saudi Arabia were the subject of this retrospective descriptive analysis. The data were presented using descriptive measures. RESULTS The mean age at diagnosis was found to be 4.9 years. Subependymal nodules (86.9%), numerous cortical tubers and/or radial migration lines (63.9%), and hypomelanotic macules (63.9%) were the 3 most common significant criteria. The vast majority (86.9%) of those diagnosed had epilepsy, of which 50% were considered medically intractable. Nearly half of our subjects underwent genetic testing, which revealed that TSC2 predominated over TSC1. Symptoms of Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders (TAND) were present in 66.7% of TSC1 patients and 73.9% of TSC2 patients. CONCLUSION The findings of this study demonstrate that the clinical spectrum of TSC among Saudi children is consistent with the body of existing literature. The TSC2 was more prevalent than TSC1. The most frequent signs were cutaneous and neurological. Monitoring TSC patients regularly is crucial to identify any issues as soon as possible.
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Affiliation(s)
- Mohammed Almuqbil
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Waad Aldoohan
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Sara Alhinti
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Nora Almahmoud
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Imad Abdulmajeed
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Rayan Alkhodair
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Amna Kashgari
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Duaa Baarmah
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Altwaijri
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Alrumayyan
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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Wang X, Ding Y, Zhou Y, Yu L, Zhou S, Wang Y, Wang J. Prenatal diagnosis and intervention improve developmental outcomes and epilepsy prognosis in children with tuberous sclerosis complex. Dev Med Child Neurol 2022; 64:1230-1236. [PMID: 35612999 DOI: 10.1111/dmcn.15265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/15/2022]
Abstract
AIM To assess whether prenatal diagnosis and early intervention are beneficial for developmental outcomes and epilepsy prognosis in individuals with tuberous sclerosis complex (TSC). METHOD This retrospective study originated from a single-centre TSC-specific cohort. We enrolled 273 individuals (138 males, 145 females; 2 years-7 years 6 months, mean 4 years 5 months, SD 1 year 6 months) with definitive TSC who completed TSC1/TSC2 genetic testing and were followed up to 2 years of age. The benefits of early attention and intervention were assessed by comparing epilepsy and developmental outcomes between groups with or without a prenatal diagnosis and with or without presymptomatic preventive intervention. RESULTS The epilepsy occurrence rate was significantly lower in individuals diagnosed prenatally than in individuals diagnosed postnatally (p = 0.027). In individuals diagnosed prenatally, the epilepsy rate in the preventive intervention subgroup was significantly lower than that in the subgroup without preventive intervention (p = 0.008). Significant improvements in cognitive, language, and motor development were observed in individuals diagnosed prenatally compared to individuals diagnosed postnatally and in the preventive intervention subgroup compared to the subgroup without preventive intervention (p < 0.05). INTERPRETATION Based on this study, we cautiously speculate that early postpartum intervention may reduce the incidence of epilepsy and intractable epilepsy and improve developmental outcomes. Prophylactic intervention with sirolimus and vigabatrin may reduce the incidence of epilepsy. Larger prospective randomized controlled studies are required to support these findings. WHAT THIS PAPER ADDS Prenatal diagnosis and early intervention may improve developmental outcomes in children with tuberous sclerosis complex (TSC). Prophylactic intervention with sirolimus and vigabatrin may reduce the incidence of epilepsy. Cardiac and/or intracranial lesions combined with genetic testing can be used to diagnose TSC prenatally.
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Affiliation(s)
- Xia Wang
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifeng Ding
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Lifei Yu
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Ji Wang
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
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